Outcomes in Hospitalized Pediatric Patients With Systemic Lupus Erythematosus

Abstract

OBJECTIVE: Disparities in outcomes among adults with systemic lupus erythematosus (SLE) have been documented. We investigated associations between sociodemographic factors and volume of annual inpatient hospital admissions with hospitalization characteristics and poor outcomes among patients with childhood-onset SLE. METHODS: By using the Pediatric Health Information System, we analyzed admissions for patients aged 3 to <18 years at index admission with ≥1 International Classification of Diseases, Ninth Revision code for SLE from January 2006 to September 2011. Summary statistics and univariable analyses were used to examine demographic characteristics of hospital admissions, readmissions, and lengths of stay. We used multivariable logistic regression analyses, controlling for patient gender, age, race, ethnicity, insurance type, hospital volume, US census region, and severity of illness, to examine risk factors for poor outcomes. RESULTS: A total of 10 724 admissions occurred among 2775 patients over the study period. Hispanic patients had longer lengths of stay, more readmissions, and higher in-hospital mortality. In multivariable analysis, African American race was significantly associated with ICU admission. African American race and Hispanic ethnicity were associated with end-stage renal disease and death. Volume of patients with SLE per hospital and hospital location were not significantly associated with outcomes. CONCLUSIONS: In this cohort of hospitalized children with SLE, race and ethnicity were associated with outcomes. Further studies are needed to elucidate the relationship between sociodemographic factors and poor outcomes in patients with childhood-onset SLE.

Significant Reductions in Mortality in Hospitalized Patients with Systemic Lupus Erythematosus in Washington State from 2003 to 2011

“…Prior studies have shown that hospital morbidity and mortality may differ based on gender, race and ethnicity. [1,6,7] While studies have evaluated and documented recent trends in decreasing hospital mortality in children with lupus,[6,7] no prior work has focused on a specific region employing hospital billing data. Our data suggests that improved survival in both children and adults with lupus in Washington State supports a nationwide trend in improved hospital outcomes.…”

“…[25] Our data does not address disease prevalence in the overall population of lupus patients who do not require hospitalization; recent work has demonstrated an association of socioeconomic status and exacerbations of lupus with disease severity in lupus. [1,6,26] Thus, comparison may be problematic due to the challenges of basing the genetics of a disease on ethnicity.…”

“…[1] Other studies have noted an increased risk for end-stage renal disease and death among black or Hispanic lupus patients. [6] Studies of pediatric lupus have shown stable hospital length of stay, but decreasing hospital mortality. [7] Few studies have examined only lupus patients with severe outcomes or have used large administrative databases with known population denominators.…”

“…[7] Few studies have examined only lupus patients with severe outcomes or have used large administrative databases with known population denominators. [1,6,7] This study examines data from hospitalized lupus patients in Washington State and provides an update to earlier studies and may improve our understanding of how demographics and clinical outcomes of patient hospitalized with lupus are changing over time.…”

Minority Pediatric Patients with Inflammatory Bowel Disease Demonstrate an Increased Length of Stay

“…36 However, in an evaluation of children with systemic lupus erythematosus using the PHIS, Hispanic children demonstrated a median LOS that was 1 day longer than non-Hispanic patients. 37 In another evaluation of pediatric patients with chronic co-morbidities and Medicaid insurance, black patients undergoing surgery were more likely to demonstrate increased LOS as compared to white patients. 38 …”